Detection of neuroendocrine tumours in the small intestines using contrast-enhanced multiphase Ga-68 DOTATOC PET/CT: the potential role of arterial hyperperfusion

Open access

Abstract

Background. Interpretation of small intestinal neuroendocrine tumours (NETs) by Ga-68 DOTATOC PET/CT can be difficult. The potential benefit of arterial hyperperfusion for the detection of NETs was evaluated.

Methods. Between 2006 and 2009, 320 consecutive Ga-68 DOTATOC PET/CT examinations, performed for NETs, revealed 40 lesions suggesting intestinal NETs in 25 patients. Two groups of lesions were distinguished: epigastric lesions evaluable in the arterial and venous CT scan (Group 1) and hypogastrial lesions evaluable in the venous CT scan only (Group 2). Lesions were jointly rated by two radiologists and a nuclear medicine physician. Maximum standard uptake values (SUVmax) of lesions and background were assessed. The reference standard was histology (available for 28 lesions) or follow-up (for a mean of 22.9 months).

Results. PET detected all suspicious lesions but was false positive in 3 lesions. In Group 1 the arterial scan performed significantly better than the venous scan (p = 0.008). Diagnostic performance was better in Group 1 than in Group 2 (p < 0.001). SUVmax of true positive lesions were significantly higher than background SUVmax (p < 0.001) and SUVmax of false positive lesions (p = 0.005).

Conclusions. The arterial phase of multiphase Ga-68 DOTATOC PET/CT might improve the localization of intestinal NETs and, thereby, improve the overall diagnostic accuracy of this modality in the assessment of intestinal NETs by adding information about lesion perfusion not available when only venous CT is performed

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Kocha W Maroun J Kennecke H Law C Metrakos P Ouellet JF et al. Consensus recommendations for the diagnosis and management of welldifferentiated gastroenterohepatic neuroendocrine tumours: a revised statement from a Canadian National Expert Group. Curr Oncol 2010; 17: 49-64.

  • 2. Modlin IM Lye KD Kidd M. A 5-decade analysis of 13715 carcinoid tumors. Cancer 2003; 97: 934-59.

  • 3. Modlin IM Latich I Zikusoka M Kidd M Eick G Chan AK. Gastrointestinal carcinoids: the evolution of diagnostic strategies. J Clin Gastroenterol 2006; 40: 572-82.

  • 4. Bornschein J Kidd M Malfertheiner P Modlin IM. Gastrointestinal neuroendocrine tumors. Dtsch Med Wochenschr 2008; 133: 1505-10.

  • 5. Slavec ZZ Gaberscek S Slavec K. The development of nuclear medicine in Slovenia and Ljubljana: half a century of nuclear medicine in Slovenia. Radiol Oncol 2012; 46: 81-8.

  • 6. Kowalski J Henze M Schuhmacher J Macke HR Hofmann M Haberkorn U. Evaluation of positron emission tomography imaging using [68Ga]-DOTA-D Phe(1)-Tyr(3)-Octreotide in comparison to [111In]-DTPAOC SPECT. First results in patients with neuroendocrine tumors. Mol Imaging Biol 2003; 5: 42-8.

  • 7. Buchmann I Henze M Engelbrecht S Eisenhut M Runz A Schafer M et al.Comparison of 68Ga-DOTATOC PET and 111In-DTPAOC (Octreoscan) SPECT in patients with neuroendocrine tumours. Eur J Nucl Med Mol Imaging 2007; 34: 1617-26.

  • 8. Gabriel M Decristoforo C Kendler D Dobrozemsky G Heute D Uprimny C et al. 68Ga-DOTA-Tyr3-octreotide PET in neuroendocrine tumors: comparison with somatostatin receptor scintigraphy and CT. J Nucl Med 2007; 48: 508-18.

  • 9. Horton KM Fishman EK. The current status of multidetector row CT and three-dimensional imaging of the small bowel. Radiol Clin North Am 2003; 41: 199-212.

  • 10. Gabriel M Hausler F Bale R Moncayo R Decristoforo C Kovacs P et al. Image fusion analysis of (99m)Tc-HYNIC-Tyr(3)-octreotide SPECT and diagnostic CT using an immobilisation device with external markers in patients with endocrine tumours. Eur J Nucl Med Mol Imaging 2005; 32: 1440-51.

  • 11. Ruf J Heuck F Schiefer J Denecke T Elgeti F Pascher A et al. Impact of Multiphase 68Ga-DOTATOC-PET/CT on therapy management in patients with neuroendocrine tumors. Neuroendocrinology 2010; 91: 101-9.

  • 12. Van Riet J Rattat D Verbruggen A Mortelmans L Mottaghy FM. Ga-68 DOTATOC PET/CT changed the therapeutic course of a patient with the sudden onset of vision problems. Clin Nucl Med 2009; 34: 27-8.

  • 13. Frilling A Sotiropoulos GC Radtke A Malago M Bockisch A Kuehl H et al. The impact of 68Ga-DOTATOC positron emission tomography/computed tomography on the multimodal management of patients with neuroendocrine tumors. Ann Surg 2010; 252: 850-86.

  • 14. Van Hoe L Gryspeerdt S Marchal G Baert AL Mertens L. Helical CT for the preoperative localization of islet cell tumors of the pancreas: value of arterial and parenchymal phase images. Am J Roentgenol 1995; 165: 1437-9.

  • 15. Stafford-Johnson DB Francis IR Eckhauser FE Knol JA Chang AE. Dualphase helical CT of nonfunctioning islet cell tumors. J Comput Assist Tomogr 1998; 22: 335-9.

  • 16. Chung MJ Choi BI Han JK Chung JW Han MC Bae SH. Functioning islet cell tumor of the pancreas. Localization with dynamic spiral CT. Acta Radiol 1997; 38: 135-8.

  • 17. Schreiter NF Nogami M Steffen I Pape UF Hamm B Brenner W et al. Evaluation of the potential of PET-MRI fusion for detection of liver metastases in patients with neuroendocrine tumours. Eur Radiol 2012; 22: 458-67.

  • 18. Andersson T Eriksson B Hemmingsson A Lindgren PG Oberg K. Angiography computed tomography magnetic resonance imaging and ultrasonography in detection of liver metastases from endocrine gastrointestinal tumours. Acta Radiol 1987; 28: 535-9.

  • 19. Wallace S Ajani JA Charnsangavej C DuBrow R Yang DJ Chuang VP et al. Carcinoid tumors: imaging procedures and interventional radiology. World J Surg 1996; 20: 147-56.

  • 20. Ricke J Hanninen EL Amthauer H Lemke A Felix R. Assessment of the vascularization of neuroendocrine tumors by stimulated acoustic emission of SH U 508A ultrasound contrast agent and color or power Doppler sonography. Invest Radiol 2000; 35: 253-9.

  • 21. Zhernosekov KP Filosofov DV Baum RP Aschoff P Bihl H Razbash AA et al. Processing of generator-produced 68Ga for medical application. J Nucl Med 2007; 48: 1741-8.

  • 22. Prabhakar HB Sahani DV Fischman AJ Mueller PR Blake MA. Bowel hot spots at PET-CT. Radiographics 2007; 27: 145-59.

  • 23. Versari A Camellini L Carlinfante G Frasoldati A Nicoli F Grassi E et al. Ga-68 DOTATOC PET endoscopic ultrasonography and multidetector CT in the diagnosis of duodenopancreatic neuroendocrine tumors: a single-centre retrospective study. Clin Nucl Med 2010; 35: 321-8.

  • 24. Ruf J Schiefer J Furth C Kosiek O Kropf S Heuck F et al. 68Ga-DOTATOC PET/CT of neuroendocrine tumors: spotlight on the CT phases of a triplephase protocol. J Nucl Med 2011; 52: 697-704.

  • 25. Prasad V Ambrosini V Hommann M Hoersch D Fanti S Baum RP. Detection of unknown primary neuroendocrine tumours (CUP-NET) using (68)Ga- DOTA-NOC receptor PET/CT. Eur J Nucl Med Mol Imaging 2010; 37: 67-77.

Search
Journal information
Impact Factor

IMPACT FACTOR 2018: 1.846
5-year IMPACT FACTOR: 1.923

CiteScore 2018: 1.94

SCImago Journal Rank (SJR) 2018: 0.651
Source Normalized Impact per Paper (SNIP) 2018: 0.867

Cited By
Metrics
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 215 82 1
PDF Downloads 97 54 1